Virginia Drama Puts Spotlight on Medicaid Expansion Holdouts

State Sen. Phillip P. Puckett speaks for his “Sunday hunting” bill during the floor session of the Virginia Senate inside the State Capitol in Richmond, Va., in February.

Associated Press

When the Supreme Court gave states the option of opting in or out of the Affordable Care Act’s Medicaid expansion, the thinking among Democrats was that after some initial grumbling states would eventually opt in.

The federal money would be too big, the argument went, and even the most ardent Republican Obamacare opponents would give in.

Then we have Virginia. As the Washington Post reported, a Democratic state senator, Phillip Puckett, from the state’s southwest corner is planning to resign Monday as part of a deal to arrange a judgeship for his daughter and a job for him on the state’s tobacco commission. The maneuver gives the GOP an immediate 20-19 advantage in the Virginia Senate – enough to block Gov. Terry McAuliffe from expanding Medicaid as part of state budget negotiations. Republicans are likely to hold Mr. Puckett’s seat in a forthcoming special election to fill his seat. The GOP already controls the Virginia House of Delegates.

Perhaps more revealing is the fact that, some two years after the Medicaid expansion became available for states, 24 still have not done so. Of those only five – Indiana, Missouri, Pennsylvania, Utah and Virginia – are even considering it, according to the Kaiser Family Foundation.

And of the states that haven’t moved and aren’t debating the expansion, only Florida, Maine and Wisconsin have competitive state elections this year in which a Democrat could feasibly win and seek to change the dynamic.

President Barack Obama spent some time in the last year trying to pressure Republican governors who had resisted the Medicaid expansion – Bobby Jindal in Louisiana, Rick Scott in Florida and Rick Perry in Texas, to name three. But those efforts largely petered out as the White House turned its focus to saving endangered Democratic senators.

Now all political eyes will watch to see how Mr. McAuliffe reacts to the machinations in Richmond. Virginia’s fiscal year ends June 30 and without a budget agreement – to which Mr. McAuliffe hoped to tie the Medicaid expansion – the state could face localized version of the government shutdown that paralyzed Washington last October.

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